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Abstract

Nearly 50 percent of individuals in the United States will develop at least one mental illness during their lifetime (Reeves et al., 2011). Although mental illness can be treated, most people with mental illness do not seek treatment (Phelan, Link, Stueve, and Pescosolido, 2000). Stigma against mental illness is considered to be a major obstacle to treatment and recovery (USDHHS, 1999). Narratives have the potential to reduce mental illness stigma (for example, Oliver et al., 2012; Chang, 2008). This study extends work on the persuasive potential of narratives by investigating the effects of a particular type of visual narrative on reducing mental illness stigma: Comics. Comics are commonly used in health communication messaging and are believed to offer cognitive and emotional benefits. Drawing on the stigma communication model, multimedia learning theory, attribution theory, risk perception, and visual persuasion as well as the concept of social determinants of health, a 3 (image type: cartoon, photo, text) x 2 (disease type: depression, bipolar disorder) between-subjects online experiment was conducted to determine whether narrative news stories about mental illness illustrated with abstract/interpretational images (specifically, cartoons, which are a key characteristic of comics) are more effective at reducing mental illness stigma than those illustrated with realistic/representational images, specifically, photographs. Results indicated that for the depression narratives, photographs elicited significantly more anti-stigma behavioral intentions, such as support for mental health policy, likelihood to share the message, and decrease in social distancing behavior, than text alone; further, these effects were mediated by identification and/or connectedness with the story's protagonist. Also, for the depression condition, mean values for the cartoon condition were not significantly lower than those for the photograph condition. For the narratives on bipolar disorder, there were no significant differences between the conditions for any of the outcome variables; however, when it came to empathic response -- identification, pity, connectedness -- the mean values for the cartoon condition were the highest. The study contributes theoretically to work on the use of narratives in stigma communication as well as provides practical implications for the use of comics in health communication messages.